Purpose To compare the efficacy between entecavir and lamivudine as prophylactic antivirus therapy on long-term outcomes of HBV carriers after kidney transplantation.

Methods We retrospectively reviewed HBV carriers with HBsAg-positive before kidney transplantation performed in our hospital from February, 2006 to December, 2012. All recipients were HBV-DNA negative before transplantation. 65 HBV carriers received entecavir as prophylactic antivirus therapy after kidney transplantation, and these patients were matched by 130 HBV carriers who received lamivudine based on HBeAg status and age. The patients were followed up, and HBV-DNA was detected every 3 months or when serum aminotransferases were abnormal. The primary endpoints were HBV reactivation (HBV-DNA transferring to positive), graft loss or patient death. Hepatic dysfunction, hepatic failure and hepatocellular carcinoma were also recorded.

Results Patients received entecavir could significantly reduce HBV reactivation rate after kidney transplantation compared to lamivudine (9.2% vs. 20.8%, p=0.043). In patients with HBeAg-positive, HBV reactivation rate was 3/15(20%) in entecavir group versus 16/30(53.3%) in lamivudine group (p=0.033). Entecavir could also reduce the incidences of hepatic dysfunction (33.8% vs. 49.2%, p=0.041). Hepatic failure (1.5% vs. 3.8%, p=0.66) and hepatocellular carcinoma rate were comparable between two groups (1.5% vs. 4.6%, p=0.276). Kaplan-Meier analysis showed that long-term patient and graft survival were also comparable between the two groups.

Conclusion Compared to lamivudine, entecavir may reduce HBV reactivation and hepatic dysfunction in HBV carriers after kidney transplantation, however patient and graft survival were comparable.

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